Related Experiment Video
Updated: Oct 24, 2025
Routine Screening Method for Microparticles in Platelet Transfusions
Published on: January 31, 2018
Rationalised premedication practice for blood product transfusions: A single-centre quality initiative
Andrew M Grant1, Felicity A Wright1,2, Tracey A O'Brien1,3
1Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, New South Wales, Australia.
Insights
Eliminating automatic premedications for acute transfusion reactions (ATRs) in pediatric cancer patients is safe. This approach, using oral antihistamines when needed, maintained low reaction rates, reducing medication risks and healthcare system burden.
Area of Science:
- Pediatric Oncology
- Transfusion Medicine
- Clinical Pharmacy
Background:
- Blood and platelet transfusions are vital supportive care for pediatric cancer patients.
- Acute transfusion reactions (ATRs) pose risks, often leading to routine premedication.
- Routine premedication carries its own risks and healthcare system implications.
Purpose of the Study:
- To prevent automatic prescribing of premedications for ATRs in pediatric cancer patients.
- To evaluate if eliminating routine premedication increases patient harm.
- To reduce unnecessary medication use and associated risks.
Main Methods:
- Intervention: Stopped automatic prescribing of IV corticosteroids and promethazine.
- Approach: Utilized a behavior change model and co-designed prescribing guidelines.
- Refinement: Three Plan-Do-Study-Act (PDSA) cycles optimized guidelines.
- Comparison: Trial data compared to international ATR rates.
Main Results:
- 100 patients received transfusions; 11 experienced reactions (initial or recurrent).
- All patients adhered to guidelines, receiving no premedication or oral antihistamines.
- No breakthrough reactions occurred with oral antihistamine use.
- Overall ATR rate was 1.33%, consistent with international data.
Conclusions:
- A restricted prescribing approach for transfusion premedication is feasible in pediatric cancer patients.
- This strategy can be implemented effectively without increasing patient harm.
- The findings support a move away from automatic premedication protocols.
Aim:
Blood and platelets are scarce resources that are an essential part of the supportive care for paediatric cancer patients. There are many inherent risks involved with transfusions including acute transfusion reactions (ATRs). Following an initial ATR, prophylactic medications are commonly given prior to subsequent transfusions. However, there are risks with medication administration as well as negative implications for the health system. Our aim was to prevent the automatic prescribing of premedications prior to blood and platelet transfusions for ATRs. We hypothesised this would not increase the risk of harm.
Methods:
Our intervention was to eliminate automatic prescribing of intravenous corticosteroids and intravenous promethazine prior to a transfusion. This was approached through a behaviour change model and the implementation of recommended prescribing guidelines. Three Plan Do Study Act (PDSA) cycles refined the guidelines to align with clinicians' needs and build support through co-design. Data gathered on individual patients receiving transfusions and reaction rates during the trial were compared to international data.
Results:
A total of 100 patients received a transfusion during the trial. Eleven patients either had a previous reaction or experienced their first reaction during this time. All patients followed the guidelines and had either no premedication or an oral antihistamine premedication. There were no breakthrough reactions using oral antihistamines. The overall reaction rate was 1.33%, which aligns with the reported data on ATRs internationally.
Conclusion:
A restricted prescribing approach to pharmaceutical cover prior to blood and platelet transfusions can be implemented effectively in a paediatric cancer population, without an increase in the risk of harm to the patients.
More Related Videos
07:40Preparation of Peripheral Blood Mononuclear Cell Pellets and Plasma from a Single Blood Draw at Clinical Trial Sites for Biomarker Analysis
Published on: March 20, 2021
12:40Preparation and Pathogen Inactivation of Double Dose Buffy Coat Platelet Products using the INTERCEPT Blood System
Published on: December 7, 2012
Related Concept Videos
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...